tbuckley/cabot-search huggingface dataset:
Abstract P358: Racial Differences in Determinants and Timing of Dropout From an Exercise Intervention: The STRRIDE Trials
Authors: Katherine A Collins, Kim M Huffman, Ruth Q Wolever, Patrick J Smith, Ilene C Siegler, Leanna M Ross, John M Jakicic, Paul T Costa, William E Kraus
Journal: Circulation (2023)

Introduction: Most adults recognize the positive health benefits of being physically active and maintaining a healthy weight, yet inactivity and obesity rates continue to rise. This disconnect is even more pronounced among racial and ethnic minorities across the United States, with Black/African American women being the highest risk group for inactivity an obesity. To begin to close this growing racial disparity gap, racial differences in exercise intervention dropout must be assessed. Hypothesis: We hypothesized that compared to their White counterpart, Black participants would dropout earlier and more often due to environmental factors. Methods: A total of 947 adults with dyslipidemia (STRRIDE I, STRRIDE AT/RT) or prediabetes (STRRIDE-PD) were randomized to either inactive control or to 1 of 10 exercise interventions, ranging from doses of 8 to 23 kcal/kg/wk, intensities of 50% to 75%VO 2 peak, and durations of 6 to 8 months. Two groups included resistance training, and one included dietary intervention (7% weight loss goal). Dropout was defined as an individual who withdrew from the study. Timing of intervention dropout was defined as the last session attended and categorized into phases. Chi-square or t -tests assessed differences in baseline characteristics by race. Results: Black versus White participants were on average younger (50.7 ± 7.7 vs. 56.0 ± 8.9 years; p&lt;0.01), however they had similar fitness levels (24.5 ± 6.0 vs. 24.7 ± 5.5 ml/kg/min; p=0.83) and body mass indexes (31.6 ± 3.1 vs. 30.8 ± 3.1 kg/m 2 ; p=0.07). Black participants were particularly more likely to dropout during the ramp period (43.1% vs. 35.4%) of the exercise intervention compared to their White counterparts. Black participants were more likely to dropout because they lacked time (43.2% vs. 38.7%), work responsibilities (26.3 % vs. 14.3%), were lost to follow-up (23.9% vs. 14.6%), had transportation issues (4.6% vs 0.0%), changed their mind (10.2% vs. 8.5%), or lack of motivation (10.5% vs. 1.3%). Conclusions: Understanding racial differences among determinants and timing of exercise intervention dropout provides key insights for future interventions aiming to optimize exercise adoption and adherence. These insights will in turn improve cardiometabolic risk among this understudied minority group.
Abstract P592: Risk Factors for Heart Failure Subtypes in a Population With a High Burden of Diabetes- Evidence From the Strong Heart Study
Authors: Irene Martinez-Morata, Arce Domingo-Reloso, Marta Galvez-Fernandez, Ying Zhang, Amanda M Fretts, Gernot Pichler, Jose Manuel Garcia Pinilla, Daichi Shimbo, Jason Umans, Shelley A. Cole, Ana Navas-Acien, Richard B Devereux
Journal: Circulation (2023)

Introduction: Heart failure (HF) is a leading cause of death. Despite the high burden of CVD and diabetes affecting American Indian (AI) communities, studies of risk factors for HF and HF subtypes in AIs are lacking and critically needed to optimize prevention strategies. Hypothesis: We hypothesize that diabetes and diabetes-related complications are HF risk factors in AIs. Methods: A total of 3,066 Strong Heart Study (SHS) participants (mean age 56.3±8.1 years, 58% women, all free of CVD) recruited in 1989-91 were followed through 2017. A total of 489 participants developed HF (119 HFpEF, 68 HFmrEF, 98 HFrEF, 204 unclassified). We used Cox proportional hazards models to determine risk factors for HF and HF subtypes progressively adjusting for sociodemographic and traditional CV risk factors (Model 1) and additionally for glycated hemoglobin (HbA1c) and albuminuria (Model 2-main model). Results: HRs (95% CI) are shown in Table 1. Age, smoking status, BMI, hypertension treatment, diabetes status, HbA1c, and albuminuria were independently associated with overall HF (Model 2). Some associations differed across HF subtypes: male sex was associated with higher risk of HFrEF and potentially HFmrEF, whereas female sex was associated with higher risk of HFpEF. BMI was associated with HFpEF but not with HFmrEF and HFrEF. Higher HDL-cholesterol was negatively associated with risk of HFmrEF and HFrEF. Diabetes was consistently associated with all HF subtypes. HbA1c was significantly associated with HFmrEF and albuminuria was significantly associated with HpEF and HFrEF. The association with diabetes status was attenuated after adjustment for HbA1c and albuminuria for all forms of HF. Conclusion: Diabetes and diabetes-related complications are major risk factors for all forms of HF in the SHS. Indicators of HF risk differ across HF subtypes. Including measures of diabetes control (HbA1c) and target organ damage (albuminuria) in HF risk calculation improves risk prediction and could aid in targeting primary prevention interventions.
Abstract P119: Circulating microRNA-122 and Improvement in Cardiovascular Health in Response to Weight-Loss Diets: The Preventing Overweight Using Novel Dietary Strategies (Pounds Lost) Trial
Authors: Qiaochu Xue, Yoriko Heianza, Xiang Li, Minghao Kou, Hao Ma, Xuan Wang, Jennifer Rood, George Bray, Frank M Sacks, Lu Qi
Journal: Circulation (2023)

Introduction: The microRNA-122 (miR-122) is widely involved in the post-transcriptional regulation of glucose and lipid metabolism, and cardiovascular system. Hypothesis: We assessed the hypothesis that decrease in circulating miR-122-5p would be associated with the improvement in cardiovascular health (CVH) score and each component health metric in response to dietary weight-loss interventions. Methods: Circulating miR-122-5p levels were measured at baseline and 6 months among 509 participants with overweight or obesity from the POUNDS LOST trial. We evaluated the CVH score using the newly updated algorithm -life’s essential 8 and calculated the composite score from the available biological health factors (body mass index [BMI], blood lipids, blood glucose, and blood pressure) across the 2-year intervention period. Results: At baseline, lower levels of miR-122-5p were associated with higher CVH scores (P&lt;0.001). Greater decreases in log-transformed miR-122-5p induced by calorie-restricted diets were significantly associated with greater improvement in overall CVH score (β[SE]= -2.98[0.7], P&lt;0.001), non-HDL metric (β[SE]= -3.72[1.33], P=0.005) and BMI metric (β[SE]= -4.78[1.12], P&lt;0.001) over 6 months. The trajectory of the composite CVH score over the 2-year intervention period differed significantly between the patterns of change in miR-122-5p ( P time*miR-122-5p =0.001). We also found a significant interaction between change in miR-122-5p and dietary fat intake on the 6-months change in CVH ( P = 0.025); a greater decrease in miR-122-5p showed a greater improvement in CVH at 6 months among participants assigned to a low-fat diet. Conclusions: In conclusion, participants with decreased circulating miR-122-5p levels in response to dietary weight-loss interventions had significant improvement in CVH and achieved CVH benefits most strongly when consuming a low-fat diet.
Abstract P123: Moderation of Associations Between Lifetime Racial Discrimination and Cardiometabolic Health by Physical Activity in the Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Melissa A Jones, Bethany Barone Gibbs, Kelley P Gabriel, Kiarri N Kershaw, Lisa M VanWiel, Tiwaloluwa Ajibewa, Raymond Jones, David R Jacobs, Kara M Whitaker
Journal: Circulation (2023)

Introduction: Racial discrimination is associated with poorer cardiometabolic health. Whether physical activity can buffer these adverse health effects is unknown. We hypothesized that greater discrimination would be associated with poorer cardiometabolic health, but associations would be blunted with higher moderate-to-vigorous physical activity (MVPA). Methods: This was an analysis of 2,129 CARDIA participants. Perceived race discrimination was reported at baseline (2000-2001) and categorized as none, moderate, or high for Black participants and none or any for White participants. Different categorization was used to account for the low percentage of White participants reporting discrimination. Health markers including blood pressure (BP), cholesterol (total, HDL-C, LDL-C), HbA1c, and C-reactive protein were measured at baseline, 5, 10, and 15 years. MVPA was measured using an accelerometer at 5-year follow-up. Race stratified mixed effects linear regression examined the main effect of race specific discrimination with health markers. Moderation by MVPA was examined by its product with discrimination in each model. Main effect estimates were computed using linear predictions at the mean and ± 1 SD of MVPA if the interaction term was p&lt;0.10. Results: Participants were 58% female, 40% black, and 45.3 ± 3.5 years of age at baseline. Contrary to our hypothesis, race discrimination was not significantly associated with health markers in Black or White participants. Significant interactions are presented in the Figure . Among Black participants, high discrimination was associated with higher HbA1c at higher MVPA (+1 SD) only. Conclusions: Perceived race discrimination was not associated with cardiometabolic health among Black or White participants though associations with HbA1c among Black participants may depend on MVPA levels in an unexpected direction. Future studies should further examine MVPA and additional factors which may be related to the health effects of discrimination among minoritized groups.
Abstract P365: Number of Beds and Volume of Patients Correlates With Increased Uptake of Novel Cardiovascular Medications in the Veterans Affairs System
Authors: Taufiq Salahuddin, Annika Hebbe, Marguerite Daus, Carol Simons, Heather Gilmartin, Jacob A Doll
Journal: Circulation (2023)

Background: Novel therapies such as angiotensin receptor-neprilysin inhibitors (ARNI), sodium-glucose cotransporter-2 Inhibitors (SGLT2i), and glucagon-like peptide-1 receptor agonists (GLP-1 RA) have well-established benefit, but use remains low for heart failure (HF) and coronary artery disease (CAD). Methods: Patients were identified by diagnosis codes for HF, myocardial infarction, or coronary revascularization between 2017-2021 at 114 sites within the Veterans Health Administration (VA). HF and CAD cohorts included 82,376 and 74,210 patients, respectively. Hospital-level data for ARNI, SGLT2i, and GLP-1 RA were assessed for filled outpatient prescriptions at hospital admission, discharge, or within 6 months of discharge. Patient and site-level characteristics were compared by high-, low-, or mixed-level use of novel medications compared with median prescribing. Results: In HF patients, rates of both ARNI and SGLT2i prescription were 20% and 21%, respectively, in 2021. In CAD patients, SGLT2i or GLP-1 RA use was 30% in 2021. Patient characteristics were similar among sites by high-, mixed- and low-level prescribing of novel medication usage. Sites in the "high" group compared with the "low" group of medication utilization had a greater number of patient-years per site (236 patient-years vs 127 patient-years, respectively, p=0.003) and a greater average number of hospital beds (157 vs 81 beds, respectively, p&lt;0.001). Though nearly all sites (95%) had an academic affiliation, a numerically greater proportion of sites in the "high" group of novel medication use had academic affiliation than the "low" group (100% vs 90% with academic affiliation, respectively, p=0.236). Conclusions: In the VA, sites with the highest utilization ARNI, SGLT2i, and GLP-1 RA use for HF and CAD had greater patient volume and number of beds than sites in the lowest-use sites. This may suggest that centers with more experience in treating HF and CAD have a more rapid uptake of novel cardiovascular therapies.
Abstract MP73: Cardiovascular Complications During Delivery Admissions Associated With Rheumatoid Arthritis: A National Inpatient Sample Analysis (2004-2019)
Authors: Salman Zahid, Mohamed Salah Mohamed, Muhammad Z Khan, Aardra Rajendran, Anum A Minhas, Noreen Nazir, Anthony Ocon, Brittany N Weber, Ijeoma Isiadinso, Erin D Michos
Journal: Circulation (2023)

Background: Individuals with rheumatoid arthritis (RA) have an increased risk of obstetric-associated complications as well as long term cardiovascular (CV) risk. However data on acute CV complications during pregnancy delivery remains limited. Methods: We used data from the National Inpatient Sample (2004-2019) utilizing ICD-9 or ICD-10 codes to identify delivery hospitalizations and a diagnosis of RA. Results: A total of 63,005,648 weighted delivery hospitalizations were identified, of which 0.1% were among persons with RA (n=62,402). Individuals with RA, vs those without, were older (median 31 vs. 28 years, p&lt;0.01) and had a higher prevalence of polycystic ovary syndrome (PCOS), gestational diabetes mellitus (GDM), obesity, and dyslipidemia (p&lt;0.01). After adjustment for age, race/ethnicity, comorbidities, insurance, and income, RA remained an independent predictor of peripartum CV complications including preeclampsia (adjusted odds ratio (aOR) 1.41 [95% CI, 1.36-1.45]), peripartum cardiomyopathy (aOR 1.80 [1.38-2.35]), and cardiac arrhythmias (aOR 2.13 [1.98-2.29]) compared with no RA. Likewise, the risk of acute kidney injury (AKI), stroke, and venous thromboembolism (VTE) were higher with RA. An overall increasing trend of obesity and GDM was also observed among individuals with RA. For resource utilization, length of stay and cost of hospitalization was higher for deliveries among persons with RA. Conclusions: Pregnant individuals with RA had higher risk of preeclampsia, peripartum cardiomyopathy, arrhythmias, AKI, stroke and VTE during delivery hospitalizations. Furthermore, cardiometabolic risk factors among pregnant individuals with RA rose over this 15 year period.
Abstract P547: Post Acute COVID Syndrome: Clinical and Laboratory Evaluation of Survivors in a Longitudinal Cohort Study
Authors: Ariele Barreto Haagsma, Rebecca Saray M Stival, Felipe Giaretta Otto, Gabriel Savogin Andraus, Cristina P Baena
Journal: Circulation (2023)

Introduction: The infection by the SARS-CoV-2 virus, initially described as an acute disease that only affected the pulmonary system, is now known to chronically affect other systems after the resolution of the acute phase. As a result, a hidden pandemic was born. Still with no clear consensus about its definition and management, post-acute Covid syndrome (PACS) is expected to be the next great burden of health services. Hypothesis: Whether sociodemographic, acute infection, current health, and physical examination variables are associated with PACS in survivors of the different forms of acute COVID-19. Methods: multicentric and observational study, patients from the city of Curitiba and its outskirts diagnosed with COVID-19 between June/2020 and Feb/2022 were referred due to persistent symptoms and evaluated with questionnaires on their acute infection and current symptoms, along with an interdisciplinary physical examination. A telephone consultation also investigated the quality of life. Patients were classified into two groups according to the National Institute for Health and Care Excellence: subacute infection (SI) and PACS. Individuals without sociodemographic and acute infection-related variables were excluded. The primary outcomes included current symptoms, modified Medical Research Council Dyspnea Scale, mini-mental state examination, multisystemic physical exam, quality of life, and new diagnoses variables, which were used in a univariate analysis to evaluate their significance in between groups. Results: 113 COVID-19 survivors were included, 63.71% were diagnosed with PACS. The mean follow-up time from the onset of acute symptoms was 104 days (IQR 46 - 163) and the overall median number of sequelae was of 9.0 (IQR 5.0 - 11.0). In the overall sample, 53.1% were women and the mean age was 51.7 ± 13.2 years. 83% were admitted to the intensive care unit and those were more likely to present with PACS (65.0%) (p=0.037). The same was observed when the use of supplementary oxygen by cannula (SI 67.5%; PACS 87.7%; p=0.022) and non-invasive ventilation were analyzed (SI 47.0%; PACS 69.7%; p=0.026). Sequelae that presented with significantly prevalence in the PACS population were (% SI; % PACS; p): dyspnea (80.5%; 59.7%; 0.036), hair loss (48.8%; 19.4%; 0.001), and upper limbs paresthesia (14.6%; 2.8%; 0.049). Meanwhile, sequelae that were found to have higher prevalence within the PACS population were: cough (17.1%; 44.4%; 0.004), gait issues (9.8%; 34.7%; 0.003); dysgeusia (2.4%; 22.2%; 0.005); anosmia (4.9%; 19.4%; 0.047); tremors (2.4%; 15.3%; 0.053); and nail alterations (2.4%; 15.3%; 0.053). Conclusion: Patients with PACS were generally also the most severe cases of acute infection, also presenting a higher prevalence of specific sequelae. These data should be reproduced in other settings and countries to help define determinants of PACS in a high-risk population.
Abstract P606: Effectiveness of Randomized Dietary Interventions for the Primary Prevention of Incident Cardiovascular Disease and Type 2 Diabetes
Authors: Alisha Shah, Suryun Kim, Rikuta Hamaya, JoAnn E Manson, Deirdre K Tobias
Journal: Circulation (2023)

Objective: Randomized controlled trials (RCTs) provide opportunities to estimate the causal effects of interventions on disease risk; however, large-scale, long-term RCTs of diet for the prevention of major chronic disease endpoints are sparse. We sought to summarize RCTs comparing the effectiveness of dietary interventions for the primary prevention of clinical cardiovascular disease (CVD) events and type 2 diabetes (T2D) in adults. Methods: We conducted a systematic review and meta-analysis (PROSPERO #CRD42021283728) of RCTs exclusively with dietary interventions with outcomes of incident primary CVD events and/or T2D among adults. We searched MEDLINE and other databases and references. Eligible interventions included those providing instruction, education, and/or provisions to modify intakes of nutrients, foods, or overall dietary patterns. We excluded meal replacement products, dietary supplements, interventions with concomitant comprehensive lifestyle programs, exercise regimens, etc., trials in secondary prevention populations, and trials assessing risk factor or biomarker changes only, rather than clinical events. Two investigators performed screening and data extraction in parallel. We conducted a random effects meta-analysis to estimate the pooled effectiveness of dietary interventions compared with usual diet or low-fat control groups for CVD and T2D outcomes, separately. Results: Among the 5365 citations generated in our searches, we identified 4 eligible RCTs, representing 56,721 participants with mean ages ranging from 44.7 to 67.9 years. Mean intervention duration was 2.3 to 8.1 years, resulting in 3,151 CVD events and 3,603 T2D cases. Compared with the control diets, the various healthy dietary patterns were related to a combined 7% (relative risk [RR] = 0.93, confidence interval [CI] = 0.87-1.00) lower CVD risk and 8% (RR = 0.92, CI = 0.86-0.98) lower T2D risk. Conclusion: Despite major morbidity and mortality from CVD and T2D, there have been few large, population-based, long-term RCTs assessing the exclusive effectiveness of dietary modification for the primary prevention of clinical CVD events or T2D. Results, however, indicate that various healthy diets may be modestly effective for primary prevention.
Abstract P617: Light to Moderate Alcohol Consumption is Not Associated With Breast Cancer Incidence in Italian Adult Women: Results From the Moli-Sani Study
Authors: Simona Costanzo, Giuseppe Grosso, Augusto Di Castelnuovo, Marialaura Bonaccio, Teresa Panzera, Chiara Cerletti, Maria Benedetta Donati, Licia Iacoviello, Giovanni de Gaetano
Journal: Circulation (2023)

Introduction: Epidemiologic studies suggest that heavy alcohol drinking is associated with unhealthy profile, whereas its light to moderate intake is associated with reduced hazard of total mortality as compared with lifetime abstention, a result largely driven by a reduction in cardiovascular mortality. Up to date, there is no agreement on a possible safe threshold for alcohol consumption in relation with cancer risk, especially breast cancer (BC) in women. Hypothesis: We assessed the hypothesis that the association of alcohol consumption with development of BC is mostly dependent on the average daily volume consumed. Methods: A prospective investigation was conducted on 11,394 women (age ≥35y) from the Moli-sani study (apparently free from any cancer at baseline; 2005-2010). The alcohol volume consumed in the year before enrolment was classified as: lifetime or former or occasional drinkers and current drinkers who drank 1-12, 12.1-24, and &gt; 24 g/d. Incident cases of BC were validated through medical and histological records. Multivariable hazard ratio (HR) and 95% confidence interval (CI) for BC were estimated using Cox proportional hazard models and multiple imputation for missing data on covariates. Results: During a median follow-up of 13.2 years, 296 BC events occurred. In comparison with lifetime abstention, intake of alcohol up to 12 g/d was not associated with BC, while consumption &gt;12 g/d had higher hazard of BC (Table). These findings remained consistent after the exclusion of BC events occurred during the first 12 months of follow-up or stratifying by BC subtypes (Table). Conclusions: Drinking up to one unit of alcohol (12 g) per day was not associated with either a protection or an increased BC risk in women. In contrast, drinking more than 12 g/d of alcohol had hazardous impact on BC incidence. These findings contribute to the current literature debate, suggesting that there is indeed an alcohol threshold below which alcohol drinking would not affect breast cancer risk.